key: cord-0743365-svkbfy2n
authors: Nguyen, Yann; Corre, Félix; Honsel, Vasco; Curac, Sonja; Zarrouk, Virginie; Fantin, Bruno; Galy, Adrien
title: Applicability of the CURB-65 pneumonia severity score for outpatient treatment of COVID-19
date: 2020-05-29
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.049
sha: c8caa9d0fa9891da5e7d5ac723788121f538e060
doc_id: 743365
cord_uid: svkbfy2n

nan

patients with CURB-65 scores of 0-1 are at low risk of death and thus may be managed as outpatients. 4, 5 However, whether CURB-65 can be applicable to COVID-19 patients for the decision outpatient treatment is still unknown.

Here, we describe a retrospective single-centre study assessing the performance of the CURB-65 to predict the risk of unfavourable outcome. Hospitalized patients aged 18 or over diagnosed with COVID-19, based on positive SARS-CoV-2 real-time reverse transcriptasepolymerase chain reaction on nasal swabs, and/or typical abnormalities on chest computed tomography (CT) were included in the study. Patients were excluded if they were directly admitted to ICU. Their baseline demographics, co-morbidities, clinical symptoms, vital signs, and laboratory results on admission were retrospectively collected. CURB-65 scores were calculated retrospectively. A poor outcome was defined as the time until transfer to the intensive care unit (ICU) for non-invasive ventilation (NIV) and/or high flow nasal cannula (HFNC) and/or invasive mechanical ventilation and/or death, whichever occurred first, within the 14 days following admission. The association between the CURB-65 and the outcome was assessed by a univariable Cox proportional hazard regression model to calculate hazard ratios (HR) and their 95% confidence intervals (95%CI). The study was approved by the local institutional review board (IRB 00006477).

A total of 279 patients hospitalized between March 15 th and April 14 th , 2020 were included in this study. Their baseline characteristics at admission are described in Table 1 . Our results showed that the CURB-65 is associated with an unfavourable outcome, and thus its application as a severity score for COVID-19 might be promising. However, while the majority of our patients would have been considered at low risk of 30-day mortality according to this severity score, more than 20% of them had a poor outcome. Our study suggests that the applicability of CURB-65 to guide the decision of inpatient or outpatient care is scarce, as it does not safely identify patients who could be managed as outpatients.

In studies of CURB-65 in the clinical practice of CAP, many patients with low CURB-65 scores are not suitable for outpatient treatment because many factors are not incorporated in the score, including hypoxemia requiring oxygen therapy, unmet social needs 6 . In addition, this score also appears to underestimate severity in young patients with CAP. Those limitations might also apply to COVID-19, whose epidemiology and severity also differ from CAP. COVID-19 is a systemic disease, and its severity might be due to virus-activated "cytokine storm syndrome", exacerbated inflammatory responses. 7 Many known risk factors, such as cardiovascular history, D-dimers, Interleukin-6, but also the myocardial involvement of COVID-19 might not be captured by the CURB-65 8-10 . decision of inpatient or outpatient care for COVID-19. There is an unmet need to have easyto-use scores to detect COVID-19 patients at risk, and to guide this decision. 

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The authors are indebted to all persons (physicians, surgeons, radiologists, biologists, medical students, and paramedical staff) who were involved in the Beaujon COVID-19 Unit. 

None of the authors declared any competing interest in link with the present study.